Affidavit
1
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvclerklOlci. miami-beach. fl. us
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRINQPAL WHO SEEKS
TO ENCOURAGE THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, ACTION OR
DECISION OF ANY COMMISSIONER; ANY ACTION, DECISION, RECOMMENDATION OF ANY OTY BOARD OR
COMMmEE; OR ANY ACTION, DECISION OR RECOMMENDATION OF ANY PERSONNEL DEFINED IN ANY MANNER
IN THIS SECTION, DURING THE TIME PERIOD OF THE ENTIRE DECISION-MAKING PROCESS ON SUCH ACTION,
DECISION OR RECOMMENDATION THAT FORESEEABLY WILL BE HEARD OR REVIEWED BY THE OTY COMMISSION,
OR A CITY BOARD OR COMMITTEE. THE TERM SPECIFICALLY INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVITIES
FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPLOYEE. EACH
PERSON WHO WITHDRAWS AS A LOBBYIST IS REQUIRED TO FILE A "CERTIFICATE OF WITHDRAWAL."
1) Lobbyist Name: --IJ ~ La h),;/,\4.e 800
Last Name First Name Middle Initial
Business Phone (30.;) 5.~- lll~
-
BUSine~Address: ciloJ ,<y., fJJl.<,r /T, hi 0
. No. U
lR,fIU,
City
Email Address: hd.{!~<k.uJ ~ . t:o'Yv)
2) Principal Retained by: :5H~1 0 1Lt.)1~
~J/ q n. t, S{, <!J:, C.J-.
If different f!,om above ) Street
hA..va.~ R
City
Message Phone (.30$")
Si3b -( I (01
~(POl>
SUite
i3:sIt>
Zip Code
()[,04 ,
S~t
II~
State
do 4/h-Jinn 6.,CA-t',p.. UJ.i;
State
Suite
S ;>,/:37
Zip Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief
officer, partner, beneficiary or interests.
-, ,
3) '"bi'" """ ("""''' ;" """U), ~:~i, I ~ ~
:::"~ fl~ :~:)A~Ja.A'~~t", { ~:!
4. Identify each individual (Commi~sioners, Board, Committee, Authorit'fmember or City. staff)
:~~ lo;~e~~ ~:='~"~9~;;: ~rv;;;;. ~n.(:l; h':' ~o~tr:;;;~
5. The subject matter in number three (3) above is to be considered at the meeting of
(Identify each entity or individual):
0 The City Commission on .2000
0 City Commission Subcommittee on ,2000
0 City Staff on .2000
0 City Board or Committee on .2000
0 Personnel on .2000
0 Identify Others on .2000
6. State the extent of any business, financial, familial, professional or other relationship which
exists with any individual identified in number (4) above:
ON OCTOBER 1 sr OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY
CLERK A SIGNED STATEMENT UNDER OATH, USTlNG LOBBYING EXPENDITURES IN
THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or
am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code as
amended, and all reporting re nts.
Signature of Lobbyist:
fI;) Personally known
l:i' Produced ID
o Did take an oath, or
o Did not take an oath
State of Florida, County of Miami-Dade
Sworn to aQcI sUbscrid~ b~..:e
Th is dot '!L day of /I 2001.
;"e."'" Elizabeth Bemor<lo
*ir*MlI Commission CC766873
~.~:; Expi"'. August 12. 2002
ct 4F IDh ,6 0 A u<a.A r-J>.
./ ,Notary o(Deputy Clerk
tbl.)~ A,A~
IrNotary, print, stamp or type as commissioned
FOR CLERK'S USE ONLY
Registration:
[vr;.CCEPTED
[ ] REJECTED
DATE: J~-o J
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No [] Not-for-Profit organ~a~
[ ] Cash [ ] Check MCR # ;1.3 cf(
DATA ENTRY DATE: . 2001 ENTERED BY: